boojit

In one of my previous posts, I responded to a comment where I say that 100 years from now, we'll look back on these times as the dark ages of psychiatric medicine. When I said this once to a psychiatrist, she was just astounded that I could think such a thing. Her view is that we've learned so much about the science of the brain. And we're running real science in the labs to test these drugs for effectiveness. There's a lot we don't know, but dark ages?

Let me explain what I mean by that.

If you've looked into depression and the science behind anti-depressants, you'll find they talk about three major neurotransmitters in the brain that are chiefly responsible for your mood, and therefore depression. These are serotonin, norepinephrine, and dopamine.

Now, the going theory is that people suffer from clinical depression because of a deficiency of one or more of these three chemicals. The question is, which one? Because the drugs don't work on all three (or if they do, as in Effexor's case, they don't do so in an easily predictable way).

The thing is, the only way to get any idea as to which one is the right one, is to start throwing these drugs at you and seeing what sticks. They haven't invented the machine yet where they just hook up a bunch of probes to your skull and it spits out "BEEP BOOP SEROTONIN SENSITIVE BEEP ALSO PATIENT WASTES TOO MUCH TIME LOOKING AT PORN ON THE INTERNET BOOP." Unfortunately for now, we're stuck with the "throw and see what sticks" method. Science is fun!

So we'll start out with serotonin because that seems to be the most common, so let's go with an SSRI (selective serotonin re-uptake inhibitor, ie: Prozac, Zoloft, Paxil, etc). OK, so we bung you full of Prozac for three months, and no change--you're still a depressing bastard and no fun at parties. OK, so let's try another one--hell we've got plenty to choose from, let's try Lexapro ...

... 5 months later (2 to get you off the Prozac, 3 to ramp you up on Lexapro)...

Nope, nothing there either. Patient is still as depressed as ever, and frankly, he's starting to get on my nerves.

So, I guess that means serotonin isn't it! I suppose next, let's try norepinephrine, which means we need something like Wellbutrin. After we spend another 2 months getting you off the Lexapro, we'll ply you full of that for 2 months. Science is fun!

...4 months later...

Wow, you're happier! I guess your deal is all about norepinephrine! No wonder the SSRI didn't work!

The problem is, of course, it's not that simple. A doctor can never say with anything like reasonable certainty which precise neurotransmitter is the one causing you to lay in bed all day in a fetal position. All they have so far is this (rather flimsy) evidence based on watching what happens when they put a couple of different weird chemicals in you.

Not to mention, none of this (flimsy) evidence gives the doctor any sort of clue as to why the Wellbutrin is giving you chronic, daily migraines that can only be kept at bay with constant and dangerously high doses of Immitrex.

The dirty little secret is that even with SSRIs (which, remember, are purported to selectively target serotonin) these drugs have far-reaching implications on your brain chemistry beyond the neurotransmitters listed here. And it is these implications that are impossible to measure, or even understand what it is we should be trying to measure.

Keep in mind that, just because we can't measure these changes to the brain chemistry, it doesn't then follow that the effects of these changes will be minimal. They can have major implications to your mood and to your body. Welcome to the happy world of side-effects!

That's why when you take a drug for ADHD which is supposed to selectively target norepinephrine (Straterra), and then a month later, you have a prostate the size of a croquet ball; the doctor just shrugs his shoulders and says, "yeah, isn't that a weird side-effect? No idea what that's all about."

This is what I mean when I say we're in the dark ages of psychiatric medication. We just don't know diddly squat yet about our own heads--and if we don't know how the brain works, then we can't really know how these drugs work either.

I'm not suggesting that these drugs don't do anything, or even that they're not theraputic. If they're working for you, then count yourself a lucky little ducky and quit listening to some crackpot's retarded blog about stuff. You win!

They didn't work for me though, and they don't work for a lot of others either. More importantly, there isn't a psychiatrist in the world who can tell you why that is.

This entry was posted on Wednesday, May 31st, 2006 at 11:39 pm and is filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.